From Spine-Health.com

Tips to prevent back pain

Although there are few studies and the medical literature does not agree on specific guidelines, parents can use common sense to reduce the chance that their child will suffer back pain due to carrying a backpack.

Look for backpack design features that help reduce the chance of back pain:

• Lightweight material (canvas as opposed to leather)
• Two padded, wide (2-inches), adjustable shoulder straps
• Padded back
• Individualized compartments
• Hip strap, waist belt or frame to redistribute weight from the shoulders and back to the pelvis
• Wheels

Teach your child how to properly load and wear the backpack:

• Always use both shoulder straps and wear the pack on the back rather than over one shoulder
• Pack heaviest objects first so they are carried lower and closest to the body
• Fill compartments so that the load is evenly distributed throughout the pack and items do not shift during movement
• Pack sharp or bulky objects so they do not contact the back
• Adjust the straps to fit the pack snugly to the child’s body, holding the bottom of the pack 2 inches above the waist and keeping the top just below the base of the skull; do not carry the pack low near the buttocks
• Lift the pack by using the leg muscles and keeping it close to the body, not by bending over with arms extended
• Do not lean forward when walking; if this is necessary, there is too much weight in the pack

Maintain a mindset to watch the weight carried in the pack:

• If the child complains of discomfort, reduce the weight immediately
• Consider applying a guideline weight limit as a percent of the child’s body weight. The American Physical Therapy Association suggests 15-20%; the American Chiropractic Association advises 5-10%.
• Coach your child to carry only those books needed, leaving unnecessary items at home and making frequent trips to his/her locker during the day
• Train your child to clean out the backpack at least once a week

Become a proactive parent on this issue:

• Ask your child if they feel any back aches or pain
• Help your child choose the smallest pack that will meet his/her needs
• Talk to teachers about how to minimize the need for children to transport heavy books back and forth daily; keep one set of books in the classroom for daily work while leaving heavy books at home; make photocopies of homework chapters and assignments that are easily carried
• Attend PTA meetings and discuss any proposal by school administrators to remove lockers or to reduce time between classes making it difficult to store unneeded books and materials

Finally, there are a number of alternatives to traditional backpacks on the market. These include saddle bags, rollerbags, packs with inflatable lumbar support and straps, totally inflatable backpacks and molded backpacks.

By: John J. Triano, DC, PhD
September 19, 2000

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From KidsHealth.org

Tips for Using Backpacks
You can't stop going to school just because your backpack is too heavy. (Sorry, this excuse doesn't work!) So what can you do? Try these tips to stop backpack pain in its tracks:

• Get the right kind of pack. Here's how:

• Make sure you have a pack with two padded straps that go over your shoulders.
• Forget about packs that go over one shoulder or across your chest (often called messenger bags) because they don't allow you to center the weight evenly over your spine.
• Look for a pack with multiple compartments inside so the weight can be distributed more evenly.

• Find a pack with a waist belt. They're great for helping to distribute the weight of your books much more evenly across your body.

• Pay attention when you pack. Put the heaviest books closest to your body when you pack your backpack to reduce strain on your shoulders and neck.

• Use your desk or locker. Don't carry around books that you don't need. Use your locker or your desk to store extra books and papers. Leave the video games and CDs at home, too - they only add to the weight of your pack.

• Don't linger with a loaded pack. The longer you carry your pack, the more pressure you're placing upon your back. If you walk home from school, drop off your backpack as soon as possible, then go back outside to play, to cut down the amount of time you're carrying a heavy load.

• Don't put off homework. Have you ever had a book report due that you let go until the last minute? Did that mean you had to lug home a backpack full of heavy library books? Try doing a little bit of homework each night so your bag won't be overflowing with books.

When you follow the backpack rules, you'll be doing your back a favor and even saving yourself from some pain!

Reviewed by: Richard Kruse, DO
Date reviewed: July 2001

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From the Medical Post

VOLUME 35, NO. 39, November 16, 1999

'Oh my aching back' is starting at a young age

By Maxine Karpen

Younger people's backpacks are causing adult-size injuries, docs find

NEW YORK - The 10th grade student presented with back and shoulder pain. Before being examined, she removed her backpack, opened it, and out rolled an assortment of books, musical instruments, athletic equipment, clothing - and a laptop computer.

The pack and its contents weighed 47 pounds.

"We've noticed an increase in children visiting our offices with muscle fatigue problems that we usually did not see until later in adult life," said orthopedic surgeon Dr. Charlotte Alexander.

Speaking at the American Academy of Orthopedic Surgeons' (AAOS) Orthopedics Update, she expressed concern "the extra stress placed on the spine from the weight of overloaded backpacks is causing unnecessary medical problems in children and adolescents."

Muscle fatigue and strain are the most frequently encountered problems, followed by back pain, shoulder pain, and headache.

In addition, the Consumer Products Safety Commission reports occasional contusions, lacerations, fractures, and eye and ankle injuries resulting from backpack use.

Surveys also indicate the excessive weight carried in packs can cause children to develop bad habits, such as poor posture or slouching, early in life.

When is a back pack too heavy? Opinions vary; the American Academy of Pediatrics feels that 20% of body weight is the cut-off point, the American Physical Therapy Association says 15% to 20%, the American Chiropractic Association says 5% to 10%.

"A survey of orthopedists concluded that a backpack could cause injury to children when its contents weigh 20% of their body weight, less for younger children," said Dr. Alexander.

"If you have a 90-pound female carrying a 20-pound backpack, then the backpack weight becomes a medical issue. Most of the students surveyed carry backpacks weighing more than 10% of their body weight."

Since students are carrying more books and equipment and have less time to visit their lockers between classes, modifying backpack use is one way to combat the problem.

Orthopedic surgeons involved in the survey recommend:

• Using a pelvic strap or girdle to transfer the weight to the pelvis
• Using a backpack with padded, wide straps and a padded back
• Using the backpack's straps, firmly tightened, to hold the pack two inches above the waist
• Placing the heaviest items close to the back
• Prioritizing the pack's contents, packing it neatly to keep items in place
• Frequent trips to lockers between classes, to replace books
• Considering a backpack with wheels
• Considering purchasing a second set of books for home

Although survey findings indicate no correlation between backpack use and serious pediatric or adolescent back conditions, Dr. Alexander stressed the importance of exercise for conditioning back muscles, and for developing proper lifting techniques.

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